FAQS
The First Embrace
  • Why practise the First Embrace?
    All babies benefit including preterm and sick, and those born by caesarean section. Aside from the natural bond it fosters, the First Embrace helps transfer warmth, placental blood, protective bacteria and – through colostrum – essential nutrients, antibodies and immune cells, to protect from infection. Hence, babies adapt better to extra-uterine life. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • Why is advance preparation necessary in the First Embrace?
    Preparing in advance facilitates organized provision of intrapartum care (e.g. gloves for sterility, vacuum suction for extraction) and immediate postpartum care (e.g. drying of baby, cord clamping). After drying and initial skin-to-skin contact with the mother, about 3% of babies will not start spontaneous breathing. Health workers cannot predict which babies these will be. Newborns suffer when the resuscitation bag and mask are not set up in advance or the equipment is faulty. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • What is wrong with taking the baby away from the mother for routine checks and then bringing the baby back?
    Separation from the mother causes distress, hypothermia and exposure to dangerous bacteria on facility surfaces to the newborn. The first breastfeeding is usually delayed because of incorrect sequencing of actions immediately after birth. Routine care such as vitamin K shot, eye prophylaxis, immunizations, examination and weighing should be postponed until after the first breastfeeding. Bathing should be delayed until 24 hours after birth. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • Why should routine care be given only after the first breastfeeding?
    The first breastfeed is often delayed because of incorrect sequencing of actions immediately after the birth. Initiating exclusive breastfeeding on baby’s feeding cues reduces the risk of death by 22%. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • Many senior doctors and midwives teach health staff to immediately suction babies after birth, to bathe the baby right after birth, and to give sugar water or formula. Should these practices be stopped?
    Yes. These are harmful practices. WHO strongly recommends against routine suctioning, which can cause apnoea, vagalinduced bradycardia, slow rise in oxygen saturation and mucosal trauma, and increase the risk of infection. It is only for babies born through meconium-stained liquor who do not breathe at birth that suctioning is recommended prior to positive pressure ventilation. Newborn babies, regardless of gestational age or weight, benefit from breast milk. Giving them anything but breast milk increases the risk of all-cause mortality and decreases the likelihood that babies will successfully breastfeed. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • Why should bathing be delayed until after 24 hours after birth?
    Immediate bathing increases risk of hypothermia – which can lead to infection, coagulation defects, acidosis, delayed fetal-to-newborn circulatory adjustment, hyaline membrane disease and brain haemorrhage. It also removes the vernix and family bacteria which protect against infection and eliminates the crawling reflex.
Preterm / Low-Birth-Weight Babies
  • Can preterm and low-birth-weight babies receive the First Embrace?
    The First Embrace is recommended for all babies regardless of gestational age or birth weight. After 30 seconds of thorough drying and being kept warm, babies who breathe well benefit from skin-to-skin contact with the mother as do other babies; additional blankets on top of the dry cover sheet give added thermal protection. It is only when the baby is not breathing well that the use of continuous positive airway pressure (CPAP)/incubator is warranted. The use of plastic bags to maintain warmth of preterm babies has not reached the required level of scientific evidence for it to be adopted. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014– 2020); WHO Regional Office for the Western Pacific: Early Essential Newborn Care Clinical Practice Pocket Guide, 2014.
  • A multi-country survey shows that we are over-treating preterm babies. What is the problem?
    Elective caesarean sections often result in preterm births. Antenatal steroids for the mother can help babies (of less than 34 completed weeks of gestational age) breathe better at birth, but this is often forgotten. Kangaroo Mother Care and appropriate feeding for preterm babies are often not incorporated into routine practice, whereas incubators and infant formula feeding are commonly included: this leads to increased risk of pneumonia, diarrhoea, necrotizing enterocolitis, malnutrition and death. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • How can we feed small babies (i.e. with less than 2.5 kg of birth weight or 37 weeks of gestational age)? What about babies below 32 weeks of gestational age?
    Breast milk is life-saving for preterm and term babies alike. Some 85% of preterm newborns are past 32 weeks of gestational age (see p. 42, Who is a preterm baby?) and have good suck-and-swallow reflex. Thus, they can breastfeed. When the baby tires, or sucks too weakly, then feeding by cup or spoon may be done. Very small babies may need tube feeding (see p. 42, Optimal feeding).
  • Can the First Embrace be used for babies delivered by caesarean section?
    Those involved in performing caesarean sections need to understand the benefits of the First Embrace. Professional societies, hospital administrators, operation theatre staff, anaesthetists, obstetricians, neonatologists, midwives and nurses together need to identify ways to enhance understanding of the benefits of First Embrace and to ensure every baby benefits from it.
  • Is it okay to feed a baby born by caesarean section with glucose water?
    Liquids other than breast milk are dangerous for all babies.
  • Should one continue breastfeeding in the presence of jaundice?
    Breastfeeding should not be interrupted due to jaundice. The underlying cause of jaundice needs to be treated; for example, if an infection, the infection needs to be treated; if phototherapy is indicated, it should be provided. Source: WHO. Recommendations for management of common childhood conditions: Evidence for technical update of pocket book recommendations: newborn conditions, dysentery, pneumonia, oxygen use and delivery, common causes of fever, severe acute malnutrition and supportive care, 2012.
  • Medicines are being prescribed for jaundice. What treatments are appropriate for jaundice management?
    Only phototherapy and, in extreme jaundice, exchange transfusion are recommended. Check bilirubin levels when jaundice is seen anywhere on Day 1 or on palms or soles at any time. Investigate causes of jaundice. (See detailed reference on next page.) Source: WHO. Recommendations for management of common childhood conditions: Evidence for technical update of pocket book recommendations: newborn conditions, dysentery, pneumonia, oxygen use and delivery, common causes of fever, severe acute malnutrition and supportive care, 2012.
  • When should I use phototherapy or exchange transfusion?
    1. Term and preterm newborns with hyperbilirubinaemia should be treated with phototherapy or exchange transfusion guided by the following cut-off levels of serum hyperbilirubinaemia. Weak recommendation, very low-quality evidence
    2. Clinicians should ensure that all newborns are routinely monitored for the development of jaundice and that serum bilirubin should be measured in those at risk:
      • in all babies if jaundice appears on day 1,
      • in preterm babies (< 35 weeks) if jaundice appears on day 2,
      • in all babies if palms and soles are yellow at any age. Strong recommendation, very low-quality evidence
    3. Phototherapy should be stopped once serum bilirubin is 50 mmol/l (3 mg/dl) or below the phototherapy threshold. Weak recommendation, expert opinion Source: WHO. Recommendations for management of common childhood conditions: Evidence for technical update of pocket book recommendations: newborn conditions, dysentery, pneumonia, oxygen use and delivery, common causes of fever, severe acute malnutrition and supportive care, 2012.
  • Many training sessions have been conducted but the practices of health-care providers have not changed. What should be done?
    Changing the behaviours of health-care providers should target an understanding of the motivation for current practices and actions needed to provide the best environment for the desired practices. Training sessions are a small part of this. A different approach to changing the practices of health workers is needed. In countries where EENC has been implemented successfully, facility-based teams used a process in each facility that included training, modifying hospital policies, changing the physical environment, and collecting simple data for decision-making. Source: WHO/UNICEF Action Plan for Healthy Newborn Infants in the Western Pacific Region (2014–2020).
  • We develop many guidelines and clinical protocols, but they are not implemented. What is your advice?
    Guidelines and clinical protocols based on good data and consistent with international standards are essential, but they are not formulated for promoting or changing practices. It is important to have enabling and coherent policies, coachingbased methods to teach practical skills, and regular review of practice using checklists, standing orders and strategies to address barriers in health facilities, such as limitations of space and equipment and in the organization of the work. It is important that key stakeholders all work together to support all aspects of practice.
  • We develop many guidelines and clinical protocols, but they are not implemented. What is your advice?
    Guidelines and clinical protocols based on good data and consistent with international standards are essential, but they are not formulated for promoting or changing practices. It is important to have enabling and coherent policies, coachingbased methods to teach practical skills, and regular review of practice using checklists, standing orders and strategies to address barriers in health facilities, such as limitations of space and equipment and in the organization of the work. It is important that key stakeholders all work together to support all aspects of practice.
  • Has WHO defined the role of obstetricians, midwives and neonatologists in newborn care?
    Countries need to develop standards of care, with roles and tasks defined for different health professional cadres based on their preservice competencies. The role of midwives is central to the delivery of care and they need to be included.
  • Is it a problem that many partners support separate EENC programmes?
    Well-meaning partners can be part of the solution or the problem. The Ministry of Health has a critical role to ensure that partners align their programmes with national standards and training. EENC is best implemented with one national approach having common goals, standards and guidelines – with all partners supporting the national approach.
  • Human resources (HR) limitations are major constraints especially in rural areas.
    Although many countries experience staff shortages, a very high percentage of all deliveries are still conducted by skilled birth attendants. The principal issue in newborn care is that the quality of care is not always consistent with international EENC standards; thus, the focus is on improving quality of care. Human resource limitations have to be addressed in long-term planning, but a lot can be done in the short term with currently available staff.
Parents
  • What is First Embrace and how can it benefit you and your baby?
    • First Embrace refers to the immediate skin-to-skin contact between you and your baby shortly after the baby is born.
    • First Embrace transfers life-saving warmth, placental blood and protective bacteria from the mother to the newborn. This simple act of love makes your baby pinker, calmer, stronger and healthier.
    • First Embrace promotes a natural bond between you and your baby.
    • First Embrace initiates exclusive breastfeeding, where babies are provided all the essential nutrients, antibodies and immune cells to protect them against diseases. Prolonged skin-to-skin contact is recommended for no less than 90 minutes.
  • What is Kangaroo Mother Care or KMC?
    • Kangaroo Mother Care or KMC is care for preterm infants through prolonged and continuous skin-to-skin contact. It is initiated in the hospital and can be continued at home (with adequate support and follow-up).
    • KMC improves the health and well-being of infants born preterm or low birth weight.
    • KMC promotes better bonding between mother and child.
    • KMC facilitates exclusive breastfeeding, which strengthens the baby’s immune system.
    • KMC provides effective thermal control, reducing the risk of hypothermia.
    • Fathers too can provide skin-to-skin contact through KMC.
  • What is exclusive breastfeeding?
    • Exclusive breastfeeding is where the infant only receives breast milk without any additional food or drink, not even water, for the first 6 months.
    • Exclusive breastfeeding protects your baby from common childhood illnesses such as diarrhoea and pneumonia, and helps for a quicker recovery after an illness.
    • Exclusive breastfeeding also contributes to health and well-being of mothers: helps to space children, reduces the risk of ovarian and breast cancer, and is a secure and low-cost way of feeding.
  • Can First Embrace apply to all types of deliveries?
    • First Embrace improves the condition of all babies including those who are premature, sick or born by caesarian section.
  • Where is First Embrace available?
    • Consult your healthcare provider to ensure you receive First Embrace. It should be available everywhere for every baby including low birth weight, premature babies or even babies born by caesarean section.